Barry Blackwell: The Baby and The Bath Water

Recent writing assignments have brought to mind the idiomatic expression; “Don’t throw out the baby with the bath water.” The phrase originates from a German book by Thomas Murner, Appeal to Fools, written in 1512, more than half a millennium ago. It is illustrated by a woodcut of a woman tossing out a baby along with waste bathwater. The use of the idiom acquired philosophical connotations in the writings of Martin Luther, Goethe and Thomas Mann, among others, presumably to denigrate those who they believed advocated foolish ideas.

Its modern usage is allied to another philosophical term, Epistemology – OED: The theory of knowledge, especially with regard to methods, validity and scope. From episteme, Greek for knowledge.

Applied to the contemporary domain of science in general and psychiatry in particular, the idiom expresses what is appropriately retained as essential and truthful or rejected as false and inessential. In medicine it can be used to segregate placebos, panaceas and snake oil from safe and effective remedies. Psychiatry probably has the most difficulty in determining what to keep and what to discard due to a paucity of valid and reliable outcome measures. Recent examples come to mind: Freud’s seductive use of deductive reasoning, embraced by John Cade (Blackwell, 2017), but artfully debunked by Michael Shepherd in his short book, Sherlock Holmes and the case of Dr. Freud, (Shepherd, 1985 ). Also the veracity of double-blind placebo controlled trials, initially regarded as the gold standard in biological psychiatry, now manipulated and debased by the pharmaceutical industry under the FDA’s blind eye (Blackwell, 2017b). Psychoanalysis and me-too drugs become candidates to be flushed with all the other forms of therapy considered lacking in value.

A willingness to throw out remedies is facilitated by false promises, such as the Nobel award for pre-frontal lobotomy and the intractable worldwide delusion that insulin coma cured schizophrenia. Such examples encourage skeptics and scientologists to metaphorically pull the plug on all biological treatments. At mid-century Peter Breggin, biological nihilists and conspiracy theorists colluded to succeed in persuading Congress to cut off all funding for brain stimulation research, effectively ending the career of Jose Delgado (Blackwell, 2013).

Such incidents have encouraged other attempts to throw out all biological treatments including ECT, lithium and even the modest effective use of a spectrum of specific drug treatments most discovered by serendipity between 1952 and 1975, but effective enough to meet contemporary epistemological standards. Primary and most forceful have been the nine books written in the 12 years between 2004 and 2016 (Blackwell, 2016) which present a compelling story of over diagnosis and drug usage described by two authors as “an epidemic” (Whitaker 2010; Schwartz, 2016). Incriminated have been ill considered legislation, a corrupt pharmaceutical industry, complicit psychiatrists, many of them academic superstars and, finally, a lax FDA, economically in thrall to the industry it regulates (Blackwell, 2017).

Some of this information is inaccurate or hyperbolic, but much is true and compelling so the overall effect is to blur the epistemological boundary between truth and falsehood, muddying the bath water and concealing a biological baby that is beloved and retained by some or reviled and cast out by others.

Applying a metaphor that has survived more than 500 years becomes a game of blind man’s bluff. Now that commerce and money trump epistemology where is the baby and who are the fools?